非小细胞肺癌患者微创切除术后的复发与转移状况研究

Recurrence and metastasis in patients with non-small cell lung cancer after minimally invasive surgery

摘要:

：目的 分析非小细胞肺癌（NSCLC）患者微创切除术后的复发与转移状况。方法 选取2008 年1 月-2013 年12 月该院行胸腔镜下肺叶切除术的123 例NSCLC 患者为研究对象，统计其围手术期资料和 随访结果，记录术后复发与转移情况，采用多因素logistic 回归分析术后复发与转移的影响因素。结果 全部 患者的中位手术时间为 165 min（ 60 ～ 430 min），中位术中出血量 95 ml（20 ～ 3 100 ml），术后共出现 15 例 （12.2%）并发症。全部患者出院后均进行定期随访，中位随访时间为23.5 个月（6 ～ 69 个月），随访期间分 别有36 例（29.3%）患者出现复发，42 例（34.1%）患者出现转移；其中，有16 例（13.0%）患者同时出现复 发与转移。同侧肺部（52.8%）是最常见的复发部位，其次是纵隔淋巴结（38.9%），骨（28.6%）是最常见的转 移部位，其次是对侧肺部（26.2%）、脑部（19.0%）。多因素logistic 回归分析结果表明，Ⅱ～Ⅲ期、纵隔淋巴 结转移、低分化是患者出现术后复发的独立危险因素（P <0.05），Ⅱ～Ⅲ期、淋巴结转移数目≥ 3 个、术后 无放化疗是患者出现术后转移的独立危险因素（P <0.05）。结论 对NSCLC 患者而言，胸腔镜下肺叶切除手 术的术后复发、转移主要发生在同侧肺部与骨，TNM 分期、纵隔淋巴结转移、分化程度、淋巴结转移数目、 术后放化疗与术后复发和转移有关。

Abstract:

Objective To analyze the recurrence and metastasis in patients with non-small cell lung cancer (NSCLC) after minimally invasive surgery. Methods 123 patients with NSCLC underwent thoracoscopic lobectomy from January 2008 to December 2013 were enrolled in the study. Their perioperative data and follow-up results were analyzed, and postoperative recurrence and metastasis were recorded. Multivariate logistics regression analysis was performed to investigate the influencing factors of postoperative recurrence and metastasis. Results The median operative time was 165 min (60 ~ 430 min) and the median intraoperative blood loss was 95 ml (20 ~ 3 100 ml). Postoperative complications occurred in 15 cases (12.2%). All patients were followed up regularly after discharge, and the median follow-up time was 23.5 months (6 ~ 69 months). During the follow-up period, postoperative recurrence and metastasis occurred in 36 cases (29.3%) and 42 cases (34.1%), including 16 cases (13.0%) patients simultaneously appeared recurrence and metastasis. The ipsilateral lung (52.8%) was the most common site of recurrence, followed by mediastinal lymph nodes (38.9%). Bone (28.6%) was the most common site of metastasis,followed by contralateral lung (26.2%) and brain (19.0%). Multivariate logistic regression analysis showed that stage II-III, mediastinal lymph node metastasis and low differentiation were independent risk factors of postoperative recurrence (P < 0.05) while stage Ⅱ ~ Ⅲ , number of lymph node metastasis ≥ 3, without postoperative radiotherapy and chemotherapy were independent risk factors of postoperative metastasis (P < 0.05). Conclusions For patients with NSCLC, recurrence and metastasis after thoracoscopic lobectomy occurred mainly in the ipsilateral lung and bone. TNM staging, mediastinal lymph node metastasis, differentiation degree, lymph node metastases, postoperative radiotherapy and chemotherapy were related with postoperative recurrence and metastasis.